WITCC Scholarship Application Summer 2016

Early Childhood Education/Early Childhood Studies/

Child Development/Paraeducator Scholarship

Priority Deadline: May 6, 2016

Final Deadline: May 26, 2016

This scholarship is only for those working or planning to work in an early childhood setting in Woodbury or Ida counties. Students not currently working must have successfully completed at least 1 semester of study in the field, reside within Woodbury or Ida counties, and have a letter of recommendation from an early childhood professional.

1.  Personal Data:

Name:
Permanent Address:
Preferred Phone Number: / WITCC Student ID Number:

2.  Education Information:

Education program in which you are enrolled:
Semester you began or are planning to begin at WITCC:
At the end of the semester, will you be eligible to apply for a paraeducator certificate? / Yes / No
At the end of the semester, will you be eligible to apply for an Associate’s degree? / Yes / No

3.  Financial Assistance Information:

All applicants are required to complete the Free Application for Federal Student Aid (FAFSA) before a SHIP Scholarship can be awarded.

Are you receiving financial assistance from any agency, program or scholarship? / Yes / No
If yes, what type of financial assistance will you receive and what is the amount?
Type of Assistance: / Amount:

4.  Employment Information:

Are you currently employed? / Yes / No
If so, who is your employer?
Is your place of employment a licensed child care center? / Yes / No
Is your place of employment a registered child care home? / Yes / No
What is your current position held? Please check one.
Teacher / Teacher Assistant / Paraeducator / In-Home Provider
Other (please explain)
If you are employed at a licensed child care center, registered home or preschool, do you participate in the following?
Choose all that apply.
NAEYC Accreditation / QPPS / QRS / HeadStart Performance Standards
Other Quality Initiative (please explain)
None of the above / Not applicable to my place of employment
Are you implementing an evidence-based curriculum at your place of employment? / Yes / No
If yes, what curriculum are you implementing?

5.  Essay:

In 300 words or less, state why you need this scholarship and how it will help you meet your goals for working with young children in a professional setting. (Add additional sheet of paper if needed)

6.  Required Documentation

Please attach at least one piece of required documentation from each category outlined below:

CATEGORY A

______Letter from current child care agency or preschool or school employer certifying employment

OR

______A copy of your in-home provider registration

OR

______A letter of recommendation if not currently working in the early childhood field

CATEGORY B

______Registration statement from WITCC showing your courses and charges

CATEGORY C

______Cost of books and required supplies by course.

Write costs on Registration Statement or print off from bookstore website.

7.  Acknowledgement and Consent

I give permission to the Scholarship Selection Committee and Siouxland Human Investment Partnership to verify my financial aid and review my transcript and application data. I further agree to comply with additional information requests from Siouxland Human Investment Partnership or Western Iowa Tech Community College.

If awarded a scholarship, I release to WITCC and SHIP the right to use my name, picture, and quotes for publications, reports and press releases.

If awarded a scholarship, I realize that I must send a thank you note to the following:

SHIP

ATTN: Director

1520 Morningside Ave

Sioux City, IA 51106

I must also send a copy of the thank you note to the Foundation Office at the address below if I would like to be considered for this scholarship in any future semester.

Signature / Date
Send application and completed packet to:
Western Iowa Tech Community College
ATTN: Foundation Office
P.O. Box 5199
Sioux City, IA 51102
OFFICE USE ONLY
Category A / Committee Recommendation
Category B / Yes / No
Category C / Committee Chair Signature:
Link to review documentation for home provider registration: https://ccmis.dhs.state.ia.us/ClientPortal/ProviderSearch.aspx